Human monocytic ehrlichiosis in children.

BACKGROUND: Much of what is known about human monocytic ehrlichiosis (HME) is based upon studies with adult patients.

PURPOSE: To review our experience with HME to better understand the epidemiology, clinical manifestations, and outcome of this disease in children.

METHODS: Demographic, clinical, and laboratory data were gathered after review of the medical records of patients identified with HME.

RESULTS: Twelve patients with an median age of 7.4 years (range, 7 months to 13.7 years) were identified with HME; 10 were white, 7 were male, and 10 were from hometowns of <800 people. Eight patients presented from May through July, and 8 had a history of tick bites. Symptoms demonstrated by the patients during their illness included fever (100%), rash (67%), myalgias (58%), and vomiting, diarrhea, and headache (25%). On presentation, patients demonstrated thrombocytopenia (92%), elevated liver function tests (91%), lymphopenia (75%), hyponatremia (67%), leukopenia (58%), and anemia (42%) on the initial laboratory examination. Four patients presented in shock and 3 required blood pressure support and mechanical ventilation for a median of 10 days (8 to 37 days). These complicated patients required longer hospitalization (19.5 days vs 5. 5 days) and attained higher blood urea nitrogen levels (42.5 mg/dL vs 10 mg/dL) than the patients not presenting with shock. Morbidity associated with HME patients included a decrease in cognitive and neurologic performance.

CONCLUSIONS: More information and long-term follow-up is required to understand the full spectrum of disease and morbidity associated with HME in children.